European Journal of Molecular & Clinical Medicine

Abstract

Objective: Differentiate the atypical angiomyolipoma from the renal cell carcinoma of
the same size by computed tomographic findings.
Introduction: A solid renal mass is a lesion without macroscopic fat that enhances
regardless of its pattern. It is important to detect the malignant one and differentiate
them from the benign one, especially when they are small. To maximize its detection
and characterization, CT includes images obtained before and after the administration
of intravenous contrast.
Materials and methods: A prospective study was carried out with 45 patients (7) with
atypical angiomyolipomas and (38) with renal cell carcinoma, all cases had been
nephrectomized (total or partial) for the resection of the lesion with subsequent
evaluation of it in the pathology center, using three-phase computed tomography
(phases without contrast, corticomedullary and early excretory) for renal cell carcinoma
less than 50 mm. Two expert radiologists individually evaluate the characteristics of the
tumor, its attenuation in phase without contrast and the characteristics of its
enhancement to differentiate the atypical angiomyolipoma from renal cell carcinoma
Results: There was a predominance of women with atypical AML (57.1% of the total; n
= 4) and of men with RCC (65.15%; n = 25), but no significant difference seen
between them. Significant difference is seen between atypical AML and RCC regarding
their contour (p-value = 0.043). In the post-contrast phase, atypical AMLs had a
homogeneous distribution enhancement in 6 cases (85.7%) and a prolonged
enhancement pattern over time in most of cases (71.4%, n= 5); regarding the RCCs
presented heterogeneity in most of cases (92.1%, n= 35) and early wash out
enhancement pattern in (81.6%, n= 31), with significant difference between them.
Conclusion: Three-phase helical CT is the standard modality for evaluate the SRM less
than 50 mm. It serves to differentiate the Atypical AML from the RCC, with the more
valuable tomographic findings are homogeneity and pattern of enhancement of renal
mass.